2016 East St. Louis Youth
One-Time Grant Application
United Way of Greater St. Louis is seeking to fund youth activities within the Greater East St. Louis area for the period of
September 1, 2016 to August 31, 2017. Funding is intended to expand programming to help prepare children and youth
for school and life by providing activities such as leadership development, relationship and life skills, cultural enrichment,
recreation, employment, academic and educational support, mentoring, and career exploration.
The target population is youth ages 5 to 21 years old and targeted zip codes are 62201, 62202, 62203, 62204, 62205,
62206, and 62207. Five grants in the amount of $25,440 will be awarded.
Agencies interested in applying for funds must complete the following application and email it along with any relevant
attachments to [email protected] by July 1, 2016 at 5pm. Late applications will not be considered. Agencies
will be notified by August 15, 2016 of funding decisions.
For questions, please contact Diane Peal at
[email protected] or 314-539-4064.
Agency Name
Federal Tax ID Number
Headquarter Address
City, State, Zip Code
Website URL
Executive Director/CEO Name
Executive Director/CEO Email
Executive Director/CEO Phone
Primary Contact Name (if different)
Primary Contact Title
Primary Contact Email
Primary Contact Phone
Year of Incorporation
Accreditation Body (if applicable)
Total Agency Budget
Program Name
To meet minimum eligibility criteria for funding, agencies that are not United Way member agencies must attach the
following documentation along with this application (use check boxes to indicate that they have been attached):
☐ Current Proof of 501(c)(3) Status
☐ Current Federal Form 990
☐ Certificate of Corporate Good Standing
☐ Most current Audit Report including auditor opinion, comments, etc.
☐ Most current Management Letters prepared by independent auditor
☐ Agency policy on compliance with USA Patriot Act and other counterterrorism laws
☐ Agency policy for background checks, including child abuse and neglect screenings
☐ Agency policy on non-discrimination
☐ Agency policy on privacy protection practices (HIPAA)
☐ Board of Directors Roster
☐ By checking here you authorize submission of this application to the United Way of Greater St. Louis, agree that
the information is accurate, and that funds will be used for the intended purpose as outlined within this application.
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GRANT NARRATIVE AND BUDGET – Not to exceed 6 pages, single spaced
1. Briefly describe your agency’s mission, goals, programs, and history of providing the proposed activities.
2. Describe the community need that this program addresses including data that supports the need.
3. Select the targeted zip code(s) your agency is proposing to serve:
☐ 62201
☐ 62203
☐ 62205
☐ 62202
☐ 62204
☐ 62206
☐ 62207
4. Describe the target population for this program, including demographics, and how you will ensure that you reach the
target population.
5. What are the specific program activities, services, and interventions provided for this target population? Include when
the program operates and where the services will take place.
6. Select no more than 3 outcome indicator(s) that best aligns with your program activities and that will be tracked:
☐ Clients are free from law enforcement/juvenile justice involvement or re-offending.
☐ Clients are free from substantiated incidents of child abuse and/or neglect.
☐ Clients are proficient in reading/math.
☐ Clients are promoted to the next grade level.
☐ Clients are ready to enter kindergarten.
☐ Clients are successfully able to manage physical health conditions.
☐ Clients are successfully linked with community services.
☐ Clients avoid bullying behaviors.
☐ Clients avoid illegal/addictive substances that negatively impact their lives.
☐ Clients develop coping, stress management skills.
☐ Clients develop healthy relationships with family members/caregivers.
☐ Clients develop positive friendships with peers.
☐ Clients develop positive self-concept/self-esteem/self-confidence.
☐ Clients develop/maintain a physically active lifestyle.
☐ Clients develop/maintain healthy eating habits.
☐ Clients develop skills to avoid engaging in risky behaviors.
☐ Clients do not become pregnant or father a child during teen years.
☐ Clients enroll in/complete job training, college, or vocational training.
☐ Clients experience a sense of belonging.
☐ Clients experience fewer mental, emotional, and/or behavioral symptoms.
☐ Clients experience no out-of-home placements.
☐ Clients feel less isolated.
☐ Clients feel more hopeful about the future.
☐ Clients gain critical thinking and decision-making skills.
☐ Clients gain knowledge about available community resources.
☐ Clients gain knowledge about behavioral/mental health issues.
☐ Clients gain knowledge about healthy lifestyle habits.
☐ Clients gain knowledge about personal finance and money management.
☐ Clients gain knowledge about physical health conditions.
☐ Clients gain knowledge about safe and healthy relationships.
☐ Clients gain knowledge and skills to prevent and respond to emergencies.
☐ Clients gain positive parenting/co-parenting skills.
☐ Clients gain strategies for enhancing safety.
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☐ Clients gain/maintain independent living/essential life skills.
☐ Clients graduate from high school, earn a GED, other high school equivalent.
☐ Clients have immediate basic needs met (food, clothing, shelter, etc.).
☐ Clients identify, manage, and appropriately express emotions and behaviors.
☐ Clients increase income, savings, and assets.
☐ Clients maintain/improve course grades/academic performance.
☐ Clients maintain/improve school attendance/remain in school.
☐ Clients maintain/improve their level of functioning.
☐ Clients maintain/improve their quality of life.
☐ Clients make changes based on knowledge gained.
☐ Clients meet or exceed age-appropriate developmental milestones.
☐ Clients obtain employment.
☐ Clients obtain job readiness skills.
☐ Clients pass their classes.
☐ Clients remain in/transition to an improved, stable living situation.
☐ Clients retain employment for at least three months.
7. What program data will be collected? What evaluation methods do you have in place to continuously use data and
outcomes to improve program quality and performance?
8. Enter the current number of clients served in the program:
9. Enter the proposed additional number of clients to be served if funding is awarded:
10. What is your agency’s capacity to deliver services to additional children and youth?
11. Complete the budget template below:
Current Agency Budget
Proposed Program Budget
Contributions
Special Events
Corporate/Foundation Grants
Government Grants/Fees
Program Service Fees
Investment Income
Miscellaneous/Other
TOTAL UNRESTRICTED REVENUE
Salaries, Benefits, Taxes, Contract Staff
Operating Expenses
Assistance to Individuals
Dues to National Organization
Occupancy Related Expenses
Depreciation
TOTAL EXPENSES
Increase (Decrease) in Unrestricted Net
Assets
12. Provide a narrative justification for the proposed budget, describing specifically how the funds will be used.
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